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首页> 外文期刊>Arthritis care & research >Identification of Biomarkers That Predict Response to Treatment of Lupus Nephritis With Mycophenolate Mofetil or Pulse Cyclophosphamide
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Identification of Biomarkers That Predict Response to Treatment of Lupus Nephritis With Mycophenolate Mofetil or Pulse Cyclophosphamide

机译：鉴定可预测霉酚酸酯或脉冲环磷酰胺对狼疮性肾炎治疗反应的生物标志物

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There is a need to identify clinical characteristics and/or biomarkers that can predict treatment outcome in lupus nephrite. To this end, we utilized data from the Aspreva Lupus Management Study to identify possible baseline and early predictors of renal response to mycophenolate mofetil (MMF) or intravenous (IV) cyclophosphamide (CYC) Methods. Patients with class III-V lupus nephritis were randomized to MMF or IV CYC. We assessed predictors of renal response, including baseline demographic, clinical, laboratory, and histologic characteristics, as well as early clinical and aboratory data, obtained within the first 2 months of therapy. Odds ratios (ORs) and 95% confidence intervals for renal response were calculated for each putative predictor.Results. Normalization of C3, C4, or both by week 8 was strongly predictive of renal response at week 24 (ORs 2 5 2 6 and 2.9, respectively; P < 0.05). Reduction in proteinuria by >25% by week 8 was predictive of renal response at week 24 (OR 3.2, P < 0.05). Reduction in anti-double-stranded DNA (anti-dsDNA) by week 8 was not predictive of renal response. Only 3 baseline characteristics (C4 level, time since diagnosis of lupus nephritis, and estimated glomerular nitration rate [GFR]) were predictive of renal response; the remaining characteristics (age, age at lupus nephritis onset, time since diagnosis of systemic lupus erythematosus, sex, histopathologic class, anti-dsDNA antibody level, C3 level level of proteinuria, and use of angiotensin-converting enzyme inhibitors, statins, or hydroxychloroquine) were not Conclusion. This study demonstrates that baseline C4 level, time since diagnosis of lupus nephritis, baseline estimated GFR, early normalization of complement, and reduction in proteinuria independently predict renal response to therapv at 6 months.
机译：需要鉴定可以预测狼疮性软脑炎的治疗结果的临床特征和/或生物标志物。为此，我们利用来自Aspreva狼疮管理研究的数据来确定肾脏对霉酚酸酯（MMF）或静脉内（IV）环磷酰胺（CYC）方法的肾脏反应的基线和早期预测指标。 III-V级狼疮性肾炎患者被随机分配至MMF或IV CYC。我们评估了在治疗的前两个月内获得的肾反应的预测因子，包括基线人口统计学，临床，实验室和组织学特征，以及早期的临床和流产数据。计算每个推定预测指标的肾反应几率（OR）和95％置信区间。在第8周时C3，C4或两者均正常化可强烈预测第24周的肾脏反应（OR分别为2 5 2 6和2.9; P <0.05）。到第8周蛋白尿减少> 25％可以预测第24周的肾反应（OR 3.2，P <0.05）。到第8周抗双链DNA（anti-dsDNA）的减少不能预示肾反应。只有3个基线特征（C4水平，自诊断为狼疮性肾炎以来的时间以及估计的肾小球硝化率[GFR]）可预测肾反应。其余特征（年龄，狼疮性肾炎发作的年龄，自系统性红斑狼疮诊断以来的时间，性别，组织病理学类别，抗dsDNA抗体水平，蛋白尿的C3水平水平以及使用血管紧张素转换酶抑制剂，他汀类药物或羟氯喹）不是结论。这项研究表明，基线C4水平，自诊断为狼疮性肾炎以来的时间，基线估计的GFR，补体的早期正常化和蛋白尿的减少独立地预测了6个月时对治疗的肾脏反应。

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